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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005447
Report Date: 06/19/2023
Date Signed: 06/19/2023 11:36:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2022 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220711084817
FACILITY NAME:LAMBERT HOME CAREFACILITY NUMBER:
306005447
ADMINISTRATOR:ASAWADILO, YANINEEFACILITY TYPE:
740
ADDRESS:8191 LAMBERT DRIVETELEPHONE:
(714) 848-1982
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
06/19/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Caregiver Paul KitnukulTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection to deliver findings on a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Caregiver Paul Kitnukul.
During course of the investigation, the Department interviewed staff, residents and witnesses as well as review and obtained pertinent documentation. The investigation conducted revealed the following:
It was alleged that the facility issued an unlawful eviction due to Resident 1( R1) receiving an eviction notice. On 6/30/22 the Department received a letter of eviction from Administrator Yaninee Asawadilokchai in regards to R1. Per the eviction notice dated 6/27/22, R1 was being evicted due to a violation of house rules pertaining to aggressive behaviors towards others in the home. Per incident reports reviewed, on 6/7/22 R1 became verbally and physically aggressive towards another resident in care; on 11/7/21 R1 became verbally and physically aggressive with staff while attempting to exit the facility unassisted; and 11/12/21 R1 became verbally aggressive with staff and began throwing food on the floor. Per facility Plan of Operation, the facility house rules prohibits residents CONTINUED ON 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 22-AS-20220711084817
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LAMBERT HOME CARE
FACILITY NUMBER: 306005447
VISIT DATE: 06/19/2023
NARRATIVE
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from engaging in violent behavior, and use of profanity or offensive language towards staff or other residents.

Although the facility had justification for issuing a lawful eviction, upon review of the notice provided, the written eviction notice failed to meet written requirements as outlined per Title 22.

Therefore, based on the preponderance of evidence reviewed, the allegation of Unlawful Eviction was determined to be SUBSTANTIATED.

The following is being cited per California Code of Regulations Title 22 Division 6.

An exit interview was conducted and a copy of this report, confidential names list and appeal rights was provided at the time of exit.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20220711084817
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAMBERT HOME CARE
FACILITY NUMBER: 306005447
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2023
Section Cited
CCR
87224(d)(1)
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87224(d)(1) Eviction Procedures. The notice to quit shall include the following information…effective date of the eviction.. resources available to assist in identifying alternative housing a statement informing residents of their right to file a complaint…
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Licensee to review the regulatory requirements for eviction procedures and provide a Eviction Notice Template requiring proper language required prior to conducting a client's eviction. Licensee to provide copy of template by due date
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The exact statement as specified in H&SC 1569.683(a)(4). This regulation was not met as evidence by: Written eviction notice to R1 did not have required language. This poses an immediate risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4